By LUCAS RESTREPO, MD
Last week, the fire department of a small town in Tennessee called South Fulton ignored the call of a man who needed help quelling a fire near his house. The firefighters declined lending a hand because the caller neglected to pay a $75 bill, the prerequisite for deserving assistance. The caller tried to put down the fire with a garden hose, but after two hours, his house caught on fire. When the property of a neighbor who had paid the $75 became threatened by the flames, the gallant firemen promptly answered the call of duty. The brave public servants prevented the flames from spreading to the property of their responsible contributor, carefully avoiding to suppress the conflagration’s source. Someone has to teach a lesson to the free-loaders in our society, explains a high-minded commentator.
Our health care system works exactly like South Fulton’s worthy fire department: we are entitled to health care only if we have money or qualify for Medicare or Medicaid. If you don’t have money, your health entirely depends on the charity of health care providers, who, as our admirable firefighters, may refuse to help.
I wish to argue that, besides being cruel and inhumane, the “South Fulton health care model” is a latent threat to society. The cost and effort of preventive medicine and basic primary care (fire prevention, putting down a small fire) is less than dealing with instances of end-organ failure (a house in flames). Moreover, having uninsured people (not aiming water to the fire source) creates a constant economic liability to responsible costumers (the neighborhood). On the other hand, why should someone become a doctor, nurse, or health insurance company founder (a firefighter) without being an altruist? Do firefighters dream of wealth and leisure?
The costs of not doing anything about a burning house are always paid in full by society ―and some costs are not immediately apparent. Who loves the sight and smell of a charred landscape? Where will the man live now that he has no house? Will he react violently to the inaction of the firemen? Will the reputation of the fire department (and the city’s) go up in smoke?
A single dispossessed is a liability to an entire society.
The Patient Protection and Affordable Care Act (PPACA) aims at controlling the “fire hazard” of the uninsured. But PPACA is being sued on behalf of a crowd of demagogues. They argue that, while Congress can regulate commercial activity, it “can’t regulate inactivity.” The pompous frivolity of such musings is not particularly persuasive. In fact, the inaction of someone who doesn’t purchase insurance generates a flurry of commercial activity elsewhere: health care companies losing money on the uninsured increase costs to their “active” costumers to make up for the loss. It’s like setting houses on fire, while asking firefighters to contain the flames without aiming their hoses to the fire source.
From a biological standpoint, if you’re “merely alive,” you are “active.” Cells proliferate beyond the reach of our volition, sustain physiological stress, micro-injury and repair; infections ensue and are fought off, while passers-by are in turn infected; some engage in unhealthy behaviors, many unbeknownst to themselves or their neighbors; heredity works its way silently toward phenotypes; furtive cells become antisocial; people grow old and forget. In other words, we are getting sick regardless of our economic activity or inactivity.
Folks suing PPACA ail from the worst kind of irresponsibility: that exhibited by those who lack solutions. They are the morally-bankrupt nihilists who fancy themselves immune to the suffering of fellow citizens. Defeated in a democratic contest, they are now poised to disassemble progress behind closed doors.
Good health is requisite for life, liberty and the pursuit of happiness. This is true for individuals, but also for societies, which are successful if their members are healthy and fair-minded.
PPACA tells us that we all have to pay the $75, but also that firefighters can’t just sit and play the lyre while our neighbor’s house burns.
Lucas Restrepo, MD, is a neurologist at the UCLA Medical Center (Los Angeles, California) and the Barrow Neurological Institute (Phoenix, Arizona). He received his medical degree from the Health Science Institute in Colombia, South America, and completed his residency training at Georgetown University in 2000 and fellowship at Johns Hopkins Hospital in 2002. His research interests include the pathophysiology and treatment of acute ischemic stroke, and the application of proteomic platforms to the diagnosis of Alzheimer’s disease. More information at: http://www.stroke.ucla.edu/staff/Restrepo_L/
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I completely agree, great aricle! I’m glad I stumbled across this website!
your ugly…
Che, unless you heard the 911 call you can’t speculate what 911 said. I only asked would they have responded if a life was threatened. From reports at least his pets died. Would you have supported no response if lives were at risk? After all a fee is a fee – isn’t it.
Good points here:
“Bob Reavis, chief of the Hornbeak Volunteer Fire Department, has come to the defense of the South Fulton department, saying Obion County government left it in an untenable situation.”
“It’s a classic case of limited government gone very bad. There are some things we all need, like police and fire protection, school and roads. But by allowing residents to pick and choose their own protection, the county left its fire departments badly underfunded, and forced firefighters to simply watch as a man’s house burned down.”
“Reavis operates his department on just $8,000 a year. Though he says 85 percent of the fires they respond to are in rural areas, those residents are the same people who allowed to choose if they want protection.”
“The county could easily add the $75 fee to property taxes, thus allowing it to buy group protection and better-funded fire departments. But it’s rejected that idea, instead allowing people to opt out for the last 20 years.”
Maybe this will be what life is like with the Tea Party running things.
“The fire department (local government) could have put a lien on his property for the fee plus penalties”.
-When? Before of after the fire?
Before the fire: Why would they do that? The fee isn’t mandatory. Makes no sense. Enforce a VOLUNTARY fee?
After the fire: What good is pile of ashes? If the property wasn’t within city limits in the first place, the city sees no value to incorporate it, or else they would have already done it.
“If parents fail to pay their property taxes do we send their children home from school?”
-logically, if they failed to pay their property taxes, eventually they would lose their home. Should they have to move out of the suburbs, yes, their children will be forced to leave the school, in this theoretical child scenario. They would have to move to an apartment, in the city somewhere.
“but what if there were children at risk in the house, would the firefighters have stood by and watched?”
-so simple you. Thanks for your theoretical what ifs. When he was on the phone with 911 dispatch do you think he WASN’T asked if there was anybody inside the burning building? What do you think dispatchers do exactly? Send out the resources without follow up questions regarding the incident?
They did ask him. He KNEW that there were no kids in the property. I can pretty much guarantee you that the call went something like:
911: 911 dispatch, what’s you emergency?
RP: Help, my house is on fire!
911: Is there anyone inside the house?
RP: No, i live alone. No one is inside.
911: Are you sure no one is inside?
RP: Yes. I am outside, watching it burn.
911:What is your adress?
RP: 123 Boondock St
911: Sir you are not on the list of rural property covered by SFFD.
RP: I know, I just forgot to pay. Please, send the firemen.
911: I’m sending the firemen now sir. Please remain at a safe distance from the structure. I’m sorry to tell you that once they get there they are not allowed to take any suppression actions, by the city ordinance of SF.
RP: Oh for the love of….
SFFD did show up, stood by, and when the fire was getting out of hand and threatened the neighboring property, that was covered by the paid $75 fee, they protected it.
It was reported that when asked if they would have fought the fire if they knew there were victims inside, the firefighters responded without hesitating, Yes.
Doctor cartel? Thanks for the validation.
And no, I do not smoke. Good for you that you don’t.
Basically striving for universal health care and turning a blind eye to the role of tobacco?
Not ignorant, just plain stupid
Any argument is false if it concludes that the government has no practical Constitutional constraint. It doesn’t matter whether that argument starts with firefighters, kittens, or the phrase “general welfare”; it’s a sophistic power grab and you can skip it. And vote those who make it out of office.
Owner says he just forgot to pay, I don’t know if that’s true and how many notices he would have gotten, but what if there were children at risk in the house, would the firefighters have stood by and watched? You need to pay your taxes and fees, but relying on a system that may not have the best checks and balances for something as important as fire protection is just dumb. If parents fail to pay their property taxes do we send their children home from school, do we refuse to send police to a 911 call? The fire department (local government) could have put a lien on his property for the fee plus penalties.
“Oh, I have seen the Peters in the ER, and they actually redefine the word “indignant” when they balk at paying for services.”
Services priced from the charge master and rigged by the doctor cartel?
“Hey Peter, do you smoke?”
No, do you?
@Peter,
“the doctor says he’s comin, but you gotta pay in cash”
“Do firefighters dream of wealth and leisure?”
– No. That being said, they also can’t afford to:
1)at the least: Be fired from a job on the basis of insubordination, (ie; in the SFFD case, it was AGAINST AGENCY POLICY to respond to a fire where the residents didn’t pay the fire protection fee).
2) at worst: Be fired AND hit with a civil and/or criminal lawsuit, should a firefighter be injured and/or killed on a response that was AGAINST AGENCY POLICY in the first place.
What prompted the fee for service in that area was a fire that happened a few years ago. The rural areas on the outskirts of the districts protected by SFFD had no fire protection agency. After the fire a few years ago, SFFD agreed to expand their response areas. SFFD had no need to expand their response area, but they did in order to help out their neighbors. The fee for fire protection was not a mysterious, in fine print, charge. The homeowner REFUSED to pay $75. He obviously didn’t expect HIS property to burn down or, his property wasn’t worth the $75 fee.
With all due respect Dr. Restrepo, basing your argument against the “pompous” masses on such an elementary analysis of an unfortunate event is, shall we say, liberal hyperbole.
Hey Jane, just beware of the doctor bashers who basically say in so many words, “treat the world for free or die!”
I’d actually pay money to watch people like Peter in the ER when they have urgent care needs.
Oh, I have seen the Peters in the ER, and they actually redefine the word “indignant” when they balk at paying for services.
Part of the reason why we have a health care crisis in the first place.
Hey Peter, do you smoke?
“I did not take a vow of poverty when I became a doctor. Love thy neighbor requires that one loves themself FIRST.”
Love to see you at a roadside accident Jane, getting checks from everyone before offering needed care.
As a physician I don’t see the problem with what the fire department did. There is only so much free care and then you have to pay. I did not take a vow of poverty when I became a doctor. Love thy neighbor requires that one loves themself FIRST.
Given that the lawsuit was recently allowed to proceed to trial, might there be a legitimate legal question as to whether the federal government has the power to impose this individual mandate. If a legitimate legal question exists, might those suing be doing so out of a sense of duty to “protect and defend the Constitution” rather than out of ignorance, moral bankruptcy, or nihilism?
Calling those with whom you disagree, “pompous,” “frivolous,” “morally bankrupt,” “nihilistic,” and “immune to the suffering of others” is strident, unprofessional, and unbecoming. Particularly when there exist reasonable arguments for both opposing the PPACA in general and the individual mandate in particular.
The story in the story is that the house that burned to the ground WAS covered by a fire insurance policy. Add to the analogy .
You have not reported anything that a good EMR, CDS, and OE, driven by cookbook paraprofessionals can not solve. Medical care should be free for everyone and anyone should be allowed in to medical school.